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Maine’s drug importation law does not endorse online pharmacies. Should it?

Sally Patterson, of Eastern Maine Homecare, holding a pill organizer, does home visits to patients in Bangor, Maine and the region, Sept. 12, 2013.
Carolyn Cole | MCT
Sally Patterson, of Eastern Maine Homecare, holding a pill organizer, does home visits to patients in Bangor, Maine and the region, Sept. 12, 2013.
Posted May 09, 2014, at 8:48 a.m.
Last modified May 09, 2014, at 10:27 a.m.

When you think about Americans ordering medication online from foreign countries, not just Canada, I want you to consider the following: 50 million Americans did not fill a prescription in 2012 due to cost. The online hunt for meds is not just about getting cheap Viagra without a prescription but obtaining needed, prescribed medication to treat, end and prevent sickness or even death. Americans across the country are under assault by high drug prices and sometimes must turn to online pharmacies located outside the U.S.

Last week, responding to a complaint brought by Kenneth McCall, president of the Maine Pharmacy Association, the Maine Board of Pharmacy asked the attorney general to issue a cease-and-desist letter to an online pharmacy called CanadaDrugCenter.com as well as launch an investigation into its actions. Under a Maine law passed last year, LD 171, licensed pharmacies in Australia, Canada, New Zealand and the United Kingdom are not banned from mailing prescription orders — for personal use — into the state of Maine, despite federal restrictions.

McCall placed medication orders on CanadaDrugCenter.com that were dispensed from Turkey, Mauritius and India. Clearly this was not the law’s intent. But there’s more to this story.

McCall’s complaint emphasized public safety, not just illegality. While the pharmacy locations may appear exotic, there was nothing unsafe about the prescription medications dispensed or how the orders were handled. Full disclosure: My business, based in New York, provides information about qualified online pharmacies and drug prices for consumers seeking lower-cost medications online. We evaluate and verify drug-selling websites, often ones located outside the U.S. If they meet certain criteria, including pharmacy licensure, prescription requirement and privacy protection, they are approved by our verification program. CanadaDrugCenter.com is one of those sites.

McCall notes in his letter that the National Association of Boards of Pharmacy, or NABP, lists CanadaDrugCenter.com on its “Not Recommended List” of sites. He quotes the NABP’s website that reads: “These websites put you and your family at risk.” Many do, but a good number on that list are safe and trustworthy, just like online pharmacies based in the U.S.

To the NABP, any non-U.S. online pharmacy that sells to Americans, including Canadian websites that only fill orders in Canada, is considered “rogue.” That classification system is highly misleading and should not be acceptable. The list makes no distinction between reputable international online pharmacies and online drug pushers who sell meds without requiring a prescription and-or counterfeit or low-quality products. While NABP claims it is independent, a grant from Pfizer paid for its Internet pharmacy classification program.

While ordering some medications from CanadaDrugCenter.com might be illegal for an American, that site is not a fly-by-night, rogue pharmacy operation. It is not a fake Canadian online pharmacy that doesn’t require prescriptions, sells counterfeit drugs, steals credit card information and engages in other unethical practices.

Let’s look at facts. McCall’s mystery shop of CanadaDrugCenter.com revealed the following: The patient sent in valid prescriptions reviewed by licensed pharmacists and real, safe and effective medications were dispensed by mail. McCall received exactly what he ordered: generic versions of Nexium, Celebrex and Plavix that were manufactured in India.

According to our research, the medicines noted by McCall were manufactured by the best drug companies in India, Cipla and Unichem, the same companies that make many of the drugs sold at your local pharmacy in Portland, Bangor or Caribou. In fact, 33 percent of prescriptions sold in U.S. pharmacies are made in India; 40 percent of medications sold in U.S. pharmacies are foreign-made; and 80 percent of the active pharmaceutical ingredients in your “American” drugs are imported (mostly from India and China).

Also, Mainers who go to CanadaDrugCenter.com have the choice of buying medications dispensed from pharmacies in Canada, Australia, New Zealand, the U.K., and even the U.S.

The U.S. Food and Drug Administration, NABP, Maine pharmacists, and even big Pharma are right: There are too many rogue pharmacy sites out there that operate under the guise of the Canadian flag but sell you fake or low-quality meds, or real meds but without requiring a prescription. We should stop them.

But let’s get real: CanadaDrugCenter.com is not one of them. It works with licensed pharmacies, pharmacists and sells high-quality medications at low prices. It did not pass itself off as just a Canadian pharmacy. Its name has “Canada” in it but its website clearly identifies that pharmacies in other countries fill prescription orders.

In some respects, the drug companies pushed Canadian pharmacies to go global. As early as 2003, companies such as Eli Lilly and Pfizer had taken actions to cut supplies to Canadian pharmacies that sold to Americans. I assume they weren’t concerned that their own drugs were unsafe, just too cheap. At that time, many Canadian pharmacies sought legitimate and safe pharmacies in other locations as partners.

Five million Americans buy medication internationally due to the outrageous prices charged domestically. There’s an ethical and public health imperative to help them. When a law interferes with people obtaining needed medication, such as current federal law, it’s a bad law. By passing LD 171 last year, state legislators determined that Maine would not condone that law. While Maine doesn’t endorse or legalize all purchases from CanadaDrugCenter.com, it should consider whether taxpayer dollars are best used toward investigating it or blocking its sales. Those resources would be better spent helping more Mainers obtain affordable medication.

Gabriel Levitt is the vice president of PharmacyChecker.com, which evaluates and verifies online pharmacies and compares prescription drug prices. Levitt also runs the PharmacyCheckerBlog, which advocates for lower drug prices for Americans.

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